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Medical Insurance CSR

Date Posted: 6/13/2024

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Job Description

Duties & Responsibilities:

* 80% - Program Support

* Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.

* Maintains departmental productivity and quality standards.

* Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction.

* Serves as a resource for other team members.

* 15% - Administrative Support

* Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.

* Addresses member and provider inquiries, questions and concerns in all areas including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care in-person or telephonically.

* Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.

* Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery.

* Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures.

* 5% - Completes other projects and duties as assigned.

Minimum Qualifications:

* High School diploma or equivalent required.

* 6 months of experience in a call center capacity required.

* Typing speed of 35 words per minute (WPM) required.

* An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

Preferred Qualifications:

* 6 months of Medi-Cal/Medicaid or health services experience.

Required Licensure / Certifications:

* N/A

Knowledge & Abilities:

* Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.

* Work independently and exercise sound judgment.

* Communicate clearly and concisely, both orally and in writing.

* Work a flexible schedule; available to participate in evening and weekend events.

* Organize, be analytical, problem-solve and possess project management skills.

* Work in a fast-paced environment and in an efficient manner.

* Manage multiple projects and identify opportunities for internal and external collaboration.

* Motivate and lead multi-program teams and external committees/coalitions.

* Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Physical Requirements (With or Without Accommodations):

* Ability to visually read information from computer screens, forms and other printed materials and information.

* Ability to speak (enunciate) clearly in conversation and general communication.

* Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.

* Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.

* Lifting and moving objects, patients and/or equipment 10 to 25 pounds

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender
To apply please email your resume to

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Job Snapshot

  • Employee Type:Full-Time
  • Location:Orange, CA
  • Job Type:Customer Service
  • Experience:1-2 years
  • Education:High School
  • Date Posted:6/13/2024
  • Contact: Shauna Cort (949) 617-3180
  • Pay Range: $23.00 - $31.00 Hourly
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Job Reference: JN -062024-369805